NET / kartsinoidnyĭ
Kakie nyeĭroendokrinnyh opuholyeĭ?
Nyeĭroendokrinnye kletki dlya proizvodstva razlichnyh gormonov mozhno naĭti v kazhdom chelovecheskom tele. Nyeobhodimye obnovleniya kletok privodit k protsessu deleniya kletok v opredelennye promezhutki vremeni. Eto delenie kletok mozhet privesti (naprimer, oslablenie immunnoĭ sistemy), chtoby porok razvitiya novyh kletok, kotorye, kak rezulʹtat izmenennoĭ geneticheskoĭ informatsii razdelitʹ chashche, i, takim obrazom podavlyaya zdorovye kletki razvivayut·sya v nyeĭroendokrinnoĭ opuholi. V otlichie ot drugih form opuholi (kartsinoma), nyeĭroendokrinnoĭ opuholi v osnovnom imyeyut znachitelʹno bolyee medlennym rostom povedeniya.
Chasto, nyeĭroendokrinnye kletki opuholi takzhe razrabotatʹ gormony (naprimer, serotonina). V rezulʹtate struktura simptomy (kartsinoidnyĭ sindrom) mozhet bytʹ: pokrasnenie oblasti golovy i shyei (Flush), diaryeyu, alkogolʹ s nimi neterpimosti, izmeneniya kozhi, astma-podobnyh zhalob.
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Diagnostika
Yadernaya meditsina diagnostike nyeĭroendokrinnyh opuholyeĭ
S momenta nachala bolyee chem polveka nazad, yadernaya meditsina diagnostika sluzhit dlya opredeleniya funktsiĭ organov i izobrazheniya fiziologicheskih i patofiziologicheskih izmeneniĭ v VIVO. Osnovoĭ dlya retseptora stsintigrafii kak molekulyarnaya vizualizatsiya protsedura yavlyaet·sya priznaniem togo, chto seriya kletochnoĭ membrany retseptory, kotorye autoradiographically obnaruzhenie s pomoshchʹyu gamma-izluchayushchie radionuklidy, takie kak 123Iod, 111Indium, 67Gallium i 99mTechnetium, a sovsem nedavno s pomoshchʹyu pozitronno-izluchateli (68Gallium, 86Yttrium) mozhet bytʹ nyeinvazivnym obnaruzheno.
Abstract
Somatostatin receptor scintigraphy (SMRS) specifically detects neuroendocrine tumours (NET) and receptor-positive metastases with high sensitivity (80 to >95%) and allows whole body diagnosis with one scintigraphic examination.
Even small primary tumours and metastases, which are difficult to diagnose with CT, MRI, or sonography, can be detected if the receptor density is high.
If there is strong suspicion of a GEP tumour, or if a NET has been proven by immunohistochemistry, SMRS should be the first diagnostic procedure for staging (before CT and MRI).
Further indications are follow-up after operation and diagnosis of recurrences in cases of increasing specific tumour markers, evaluation of the therapeutic response after chemotherapy or biotherapy, and differential diagnosis of neuroendocrine tumour vs. non-endocrine tumour in cases of a space-occupying mass if a final diagnosis cannot be obtained by biopsy or operation.
Finally, there is an essential role for somatostatin receptor scintigraphy in the pretherapeutic evaluation (receptor density) before peptide receptor radiotherapy and in the follow-up after treatment.
Keywords:
Neuroendocrine tumours/carcinomas • carcinoid • GEP tumours • Somatostatin receptor scintigraphy • nuclear medicine diagnosis
Authors:
R. P. Baum • M. Hofmann
Klinik für Nuklearmedizin/PET-Zentrum,
Zentralklinik Bad Berka GmbH
Medizinische Hochschule Hannover
Published in:
Onkologe 2004 • 10:598–610 DOI 10.1007/s00761-004-0716-1
Published online:
4 June 2004 © Springer-Verlag 2004
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Terapiya
Peptidnyĭ retseptor luchevoĭ terapii (PRRT) nyeĭroendokrinnoĭ opuholi
Klinicheskie pokazaniya i opyt raboty s 90Yttrium mechennogo analoga somatostatina
Radionuklidnaya mechennyh somatostatin analoga takih kak 111Indium-oktryeotida (OctreoScan) ili 99mTechnetium-ED-DA-HYNIC-TOS (TETOC) byli uspeshno ispolʹzovany v techenie ryada let v diagnostike nyeĭroendokrinnyh opuholyeĭ.
Po prichine svoego blagopriyatnogo biokinetic harakteristiki (bystroe i obogashcheniya v opuholʹ, bystroe oformlenie krovi) i razvitie stabilʹnyh protsedury markirovki s b-izluchayushchih radionuklidov, oni byli bolyee razvernutymi v poslednie gody v terapii radio peptid dlya additivnoĭ lechenie nyeĭroendokrinnoĭ, osobenno zheludochno-entero-podzheludochnoĭ zhelezy, opuholi (tak nazyvaemyĭ peptid radioterapii retseptor, PRRT ili terapiya radio retseptor, RRT, dlya kratkosti).
Naryadu s traditsionnymi stolpa lecheniya onkologicheskih zabolevaniĭ (operatsii, mestnye protsedury lecheniya, chemo-/biotherapy) radionuklidnoĭ terapii otkryvaet novuyu optsiyu osobenno dlya lecheniya patsientov, pokazyvayushchie razvitie bolezni prohodyat kurs lecheniya s oktryeotida (ili kombinatsiyu oktryeotida plyus interferon ) ili posle protsedury mestnoĭ terapii takih kak chemoembolisation ili takzhe sleduyushchie ablyatsionnoe protsedur (radiochastotnaya ablyatsiya, LIT).
Operativno, mestnye ili regionalʹnye Loco-operatsii s uchastiem obychno rezektsiya pervichnoĭ opuholi mozhet bytʹ osushchestvlena s lechebnoĭ namerenii, a v sluchae nalichiya otdalennyh metastazov operatsiya yavlyaet·sya yedinstvennym uspeshnym v techenie ogranichennogo perioda.
Poskolʹku mnogie nyeĭroendokrinnyh opuholyeĭ pokazyvatʹ medlennyĭ rost (nizkaya skorostʹ razmnozheniya), himioterapiya chasto ne ochenʹ effektivny i v sluchae dolgosrochnyh primenenie svyazano s pobochnymi effektami (nizkie terapevticheskie shirinu).
To zhe samoe otnosit·sya i k vneshnim luchevoĭ terapii; ono redko ispolʹzuet·sya, naprimer, dlya bonymetastases ili nedifferentsirovannye raki s vysokim urovnem rasprostraneniya (a zatem osnovnom palliativnogo). Yadernoe meditsinskoĭ terapii s otkrytymi radioaktivnymi veshchestvami osnovano na tom, chto konkretnye metabolicheskie protsessy ili sotovyĭ harakteristikami mogut bytʹ ispolʹzovany v tselenapravlennoĭ.
Naibolyee izvestnym yavlyaet·sya lechenie hyperthyreosis i differentsirovannyh kartsinom shchitovidnoĭ zhelezy s radioaktivnym ĭodom (radio-ĭoda terapiya), kotoraya byla sozdana 60 let i s kotoroĭ milliony patsientov proshli uspeshnoe lechenie vo vsem mire. Radio-ĭod terapii Metodologicheski ochenʹ pohozhi na retseptory terapii, tak kak prinyatʹ po itogam 3 ĭoda v kletkah proishodit cherez konkretnye mehanizmy (natriya / Ĭodid Symporter = NNG). Sushchestvovanie spetsificheskimi retseptorami na poverhnosti kletok nyeĭroendokrinnyh opuholyeĭ delaet vozmozhnym tochnoe svyazyvanie ligandov s retseptorami somatostatina retseptorov.
Somatostatin analog (tak kak DO-TA-TOC, DOTA-TATE, DOTA-NOK) melkie peptidy, kotorye mogut bytʹ oboznachen znakom, radioaktivnye izluchateli, takie, kak terapevticheskoe b-izluchatelʹ 90Yttrium, i posle vnutrivennogo (ili vnutriarterialʹnyĭ) inʺektsii svyazyvatʹ k opuholi ili metastazov i obluchatʹ yego "iznutri", tak kak radio-farmatsevticheskiĭ obogashchaet konkretno v opuholi ( "vnutrenniĭ radionuklidnoĭ terapii").
Opublikovano v:
Der Onkologe 10 · 2004,
by R. P. Baum · J. Söldner · M. Schmücking · A. Niesen
Klinik für Nuklearmedizin/PET-Zentrum,
Zentralklinik Bad Berka
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